[Sertraline. Adverse effects due to the superposition of serotonic and malignant neuroleptic syndromes]. / Sertralina. Efectos adversos por superposición de manifestaciones de síndromes serotóninico y neuroléptico maligno.

A 57 year-old man chronically treated with 50 mg daily of sertraline was admitted to the emergency room with mental status changes, rigidity, seizure activity and autonomic instability. He was rapidly transferred to the Intensive Care Unit. Laboratory determinations revealed increases in serum enzymes, prevailing creatine phosphokinase with a peak level by the third day of 35,000 Ui/L. Initial low serum sodium (10 mEq/L) was attributed to inadequate antidiuretic hormone secretion. Supportive care included discontinuation of sertraline and lorazepam administration. Mental status, and rigidity returned to baseline within 60 hours. Differential diagnosis between the neuroleptic malignant syndrome and the serotonin syndrome could not be determined accurately because of the striking overlap of signs and symptoms of both syndromes.